INTEGRATING A COMMUNITY HEALTH

WORKER CERTIFICATE INTO AN

ASSOCIATES DEGREE

Janet Lavin Grant, MSPH and Becky Lewis MSW, MPH

Holyoke Community College

Foundations of Health Department

League of Innovations Conference

Baltimore, MD

Brief Participant Survey

Presentation Objectives

• Describe the competencies needed by CHWs in Massachusetts

• Discuss how the CHW certificate fits into the emerging field of community health at community colleges across the U.S.

• Identify potential strategies, challenges and opportunities in certificate development, curriculum development, implementation, and assessment.

• Explain how proactive advising and community outreach to both employers and potential students have been integral to the success of the program.

• Examine the benefit and challenges of a stack-able certificate that straddles multiple disciplines (e.g. Human Services and Health Sciences) to their constituency and if they would be able to use this model at their institution or organization.

OVERVIEW OF HOLYOKE

COMMUNITY COLLEGE

OUR STUDENTS

“Who” Goes to Holyoke Community

College • HSI status – Awarded Fall 2016- at least 25% of student

population is Hispanic

• Approx 50% of students come from the small-to-medium

cities of Springfield, Holyoke, Chicopee, and Westfield

• Holyoke Public Schools registered 200 students by

January 16 post Hurricane Maria

• HCC enrolled approx 50 students post hurricane Maria

from Puerto Rico

• City of Holyoke has 2nd largest number of residents from

Puerto Rico in State of Massachusetts

• Gap between health interest and entrance into selective

programs

Our student body reflects many of the same populations

that CHWs often serve:

• Low-Income

• People of Color

• First-Generation College Student

• Bi-lingual

• Bi-Cultural

• Veterans

• Students with Disabilities (including behavioral health

issues)

• Receive financial aid/Pell-eligible

Social Determinants of Health

• Food Insecurity

• Homelessness

• Housing Quality

• Access to Healthcare

• Intergenerational trauma

• Education & Employment

• Health disparities

WHAT IS A COMMUNITY

HEALTH WORKER?

Community Health Worker

• Through applying their unique understanding of the community they serve:

• Provides culturally appropriate outreach and health education

• Navigates health and human service systems

• Assures full and equal access to health and social services

• Advocates for individual and community health needs

• Builds the capacity of individuals to improve their own health and the health of others

http://www.machw.org/index.php?option=com_content&view=article&id=25&Itemid=131

Access 3/16/17

Massachusetts Department of

Public Health

American Public Health

Association

Department of Labor

Affordable Care Act

MassHealth Pilot 2018

EFFECTIVENESS OF

CHWS

Children’s

Hospital of

Boston

Community

Asthma Initiative

Study

https://docs.google.com/viewer?a=v&pid=sites&srcid=bnBhLXJoZWMub3JnfHJlZ2lvbjF8Z3g6NzhmYmNkO

WYyZTlhZGE5MQ Accessed 4/17/2017

Denver/Molina Study Measuring Return on Investment of

Outreach by Community Health Workers (M2006)

• Tracked spending on primary and specialty care, urgent care,

inpatient and outpatient behavioral health care.

• ROI estimate of $2.28 saved per dollar spent.

• Costs included in the investment were limited to direct personnel

costs. Not included were program development, management,

or evaluation.

• Used in state of Massachusetts to lobby for CHW

certification and inclusion in Medicaid-reimbursable

activities

HISTORY &

CERTIFICATION OF CHWS & (ACO) Certification Program in Massachusetts

History of CHWs

Prior to 1970:

China

Mexico

USA

’80’s and ‘90’s:

HIV/AIDS Epidemic

Maternal/child Health

Early 2000’s

South Africa 2006

Health Care Reform in MA

2018

2009

DPH Office

CHWs

2010

Chapter 322

“An Act to

establish a

Board of

Certification for

Community

Health

Workers”

Massachusetts 10 Core Competencies

Outreach Methods &

Strategies

Care Coordination & System

Navigation

Individual & Community

Assessment

Use of Public Health

Concepts & Approaches

Effective Communication Advocacy & Community

Capacity Building

Cultural Responsiveness &

Mediation

Documentation

Education to Promote

Healthy Behavior Change

Professional Skills &

Conduct

Education/Training for CHWs

80 hours training

• 64 Core Competency training

• 16 special health topics

• Can be partially online

CHW Trainers as part of team

• Required minimum 40% of the time

Interactive Learning Methods

• Role play

• Simulation

Flexibility in curriculum design and

delivery

Components

of Required

Training

Massachusetts Health Policy Commission:

Accountable Care Organization (ACO) Certification

Program

• A program designed to accelerate care delivery transformation in Massachusetts and promote a high quality, efficient health system.

• Pursuant to G.L., c. 6D, §15, the HPC is required to "establish a process for certain registered provider organizations to be certified as accountable care organizations."

• The purpose is to complement existing local and national care transformation and payment reform efforts, validate value-based care, and promote investments by payers in efficient, high-quality, and cost-effective care.

• Approved: April 27, 2016

• CHWs can now be reimbursed under Mass Health as part of healthcare team

EVOLUTION OF CHW

CERTIFICATE AT HCC

Foundations of Health Program

FOH Transfer Degree (A.A.)

Community Health Worker Certificate

Direct Care Worker Certificate

Medical Billing & Coding Certificate

Medical Assisting Certificate

FOH Career

Degree (A.S.)

History of CHW Certificate Funding at HCC

2013

2015

2017

Next? • ACO, Medicaid, Dual Enrollment

“Stacking” CHW Certificate

• Had existing FOH Career Degree

• Most logical place to embed CHW certificate

• Students can just enroll in certificate and complete, or can

enroll in degree first then choose certificate

• CHW/Public health classes also count towards human

services degree

• We are working on stacking CHW certificate into our

human services degree (adding Children’s behavioral

health classes)

• Also considering public health degree in future

“Stacking” CHW Certificate

Why

Allows students to integrate workforce skills into academic degree for career advancement

Provides flexibility for students who may otherwise not choose to complete a degree

Students can just enroll in certificate and complete, or can enroll in degree first then choose certificate

How

Spoke to employers on advisory board about what courses/content to include

Used Existing FOH Degree- created CHW Certificate as one of four certificate options

We are working on stacking CHW certificate into our human services degree (adding Children’s Behavioral Health classes)

How can this certificate be “stacked”?

Future Directions for CHW Certificate

Stack into Human Services Degree

2019

Multiple Tracks:

Addiction

Post-Incarceration

General

2020

Stacks into Interdisciplinary Public Health

Degree

2021

Case study: (José)

• Some college completed in Puerto Rico

• Worked 25+ years as a cook

• Cannot do that work anymore due to chronic back problems.

Background

Education/Career Interest

• Interested in studying Nutrition

• Discussed education needed to become RD; interested in diabetes education

• Eligible for Training Opportunities Program

• Explored CHW as a career pathway by taking HTH 104 SP2017

Barriers

• Income

• Lost eligibility for Training Opportunities Program

• Family

Success

• Completed two full semesters of Community Health

Worker Certificate Program.

• Will complete full certificate Spring 2018

• Interested in continuing for a degree in Nutrition

Tenets of Proactive Advising

• Regular outreach to students (phone, email,

social media)

• Advising embedded in core classes (HTH 101)

• Emphasis on relationship building from Day One

• Every student in CHW Certificate is assigned an

individual advisor

HRSA- BHWET FUNDING: TO

TRAIN COMMUNITY HEALTH

WORKERS

About Our HRSA Funding

• HCC awarded 4-year, $431,000 grant from HRSA- BHWET

• Grant pays up to $3,000.00 per student in a 12 month

period

• Develop paraprofessional workforce of underrepresented

students in community health worker role, integrating

behavioral health into primary care

• Students take 3 credit- bearing classes

• 1 course per term/semester

• Enrolled in college

• Certificate of completion

About the Classes/Training

HTH 104-Core Competencies for CHW (4cr)

HTH 201-Essential Health Topics (2cr) OR

HSV 140-Children’s Behavioral Health (3cr)

HTH 209-Practicum for CHWs (3cr)

*Classes offered 2

evenings (6-9) a week

or on Saturdays (10-4) *Classes completed in

12 months; 1 per

semester

Criteria for Eligibility

HCC HRSA Funded CHW

Classes

Incumbent Worker (ideally)

College English eligible

Cori/Sori, Drug testing/Immunizations (practicum)

Commit to completion of

3 classes [sans

absences]

Important Courses

Core Competencies for CHW (4 credits)

Essential Health Topics ( 2 credits)

Practicum for CHWs(3 credits)

Intro to Public Health (3 credits

Required for

DPH

Certification

Counts as social science

elective and fulfills course

requirement at UMass

CHW CERTIFICATION: A

NATIONAL MOVEMENT

Massachusetts Association of Community

Health Workers

CHW Education at Community Colleges

in Massachusetts

2+ colleges offer:

• Specific courses for college credit

• Not part of an academic certificate

3 colleges offer:

• Public health associates degree

• CHW/Community Health Certificate embedded

5+ colleges offer:

• CHW specific academic certificate for college credit

• Not necessarily part of an associates degree

Overview of CHW Wages/Hours/Education

Opportunities for Advancement

$15/hour

None to some training in core competencies or experience

$20/hour

Some formal training in core competencies

Some experience and/or associates degree

$40/hour

Formal training in core competencies

Plus other education, certificates, degrees (Bachelors or higher) and years of experience

Examples of Where Our Students are

Working…..

• Holyoke YMCA facilitating a Diabetes Prevention Program/Healthy Weight and Your Child...

• Behavioral Health Network as a Care Coordinator based at Holyoke Health Center

• AIC Grad who completed course working in Elder Human Services Agency

• Immigrant Resettlement Specialists-Staff at Jewish Family Services have completed Core Competencies course

• Holyoke Health Center

CHALLENGES & LESSONS

LEARNED

Lessons Learned: Internal

• Low enrollment

• Educating colleagues/administration, etc. about

what a CHW is

• Internal Recruitment-within college continues to be

a challenge

• Location & Timing of classes for incumbent workers

Lessons Learned: External

• How to effectively partner with employers/community

partners

• Marketing/communication- who is our audience?

• Selling value of taking for college credit when offered as

workforce training (stuck on academic calendar)

• Recruitment of incumbent workers given lack of steady

employment

• Lack reimbursement, jobs

ACTIVITY: APPLICATION OF THIS INFORMATION TO

YOUR PROGRAMS/SCHOOLS

This project is supported by the Health

Resources & Services Administration (HRSA)

of the US Department of Health & Human

Services (HHS) under M01HP31268 Behavioral

Health Workforce Education & Training

(BHWET) Program. This information or content

and conclusions are those of the author and

should not be construed as the official position

or policy of, nor should any endorsements be

inferred by HRSA, HHS, or the US Government.

Questions?

Thank You!

Janet Lavin Grant: Jgrant@hcc.edu

(413) 552-2445

Rebecca Lewis: rlewis@hcc.edu

(413) 552-2426